When Eating Right, Is Measured Wrong! A Validation and Critical Examination of the ORTO-15 Questionnaire in German

Abstract

The characteristic trait of individuals developing a pathological obsession and preoccupation with healthy foods and a restrictive and avoidant eating behavior is described as orthorexia nervosa (ON). For ON, neither universal diagnosis criteria nor valid tools for large-scale epidemiologic assessment are available in the literature. The aim of the current study is to analyze the psychometric properties of a translated German version of the ORTO-15 questionnaire. The German version of the ORTO-15, a eating behavior and dieting habits questionnaire were completed by 1029 German-speaking participants (74.6% female) aged between 19 and 70 years (M = 31.21 ± 10.43 years). Our results showed that after confirmatory factor analysis, the best fitting model of the original version is a single-factor structure (9-item shortened version: ORTO-9-GE). The final model showed only moderate internal consistency (Cronbach’s alpha = .67), even after omitting 40% of the original question. A total of 69.1% participants showed orthorectic tendencies. Orthorectic tendencies are associated with special eating behavior features (dieting frequency, vegetarian and vegan diet). Education level did not influence ON tendency and nutritional students did not show higher ON tendency compared to students from other disciplines. This study is the first attempt to translate and to evaluate the psychometric properties of a German version of the ORTO-15 questionnaire. The ORTO-9-GE questionnaire, however, is only a mediocre tool for assessing orthorectic tendencies in individuals and shows moderate reliability and internal consistency. Our research suggests, that future studies are needed to provide more reliable and valid assessment tools to investigate orthorexia nervosa.

Interaction between Vegetarian Versus Omnivorous Diet and Unhealthy Eating Patterns (Orthorexia Nervosa, Cognitive Restraint) and Body Mass Index in Adults

“…Our results indicated that vegetarian diet was directly associated with higher levels of all aspects of orthorexia nervosa (knowledge of healthy eating, problems associated with healthy eating and feelings positively about healthy eating) (H1 was confirmed). These findings are in line with prior studies in the literature that also find that higher rate of orthorexic behaviors was linked to a vegetarian diet [12,17,[40][41][42]. It can be supposed that a vegetarian diet might increase the risk of developing orthorexia nervosa [11].…”

A Case Report of an Adult Male Patient With Avoidant/Restrictive Food Intake Disorder Treated With CBT

“…Another research previously described the increased rate of ON among ED patients after treatment (Segura Garcia et al 2015). Two explanations can be given to this result: a) this orthorexic score could be an iatrogenic-like side effect of CBT, but according to clinical interview was not confirmed, b) the result was a false positive: a recent research has highlighted the lack of statistical power of the ORTO-15 (Missbach et al 2015).…”

Orthorexia nervosa, eating patterns and personality traits: a cross-cultural comparison of Italian, Polish and Spanish university students

“…On the other hand, Italy has a widely recognized culture about eating and nutrition and the Mediterranean diet has long been praised for its general health benefits and a strong attention paid to taste [58]; a similar situation is found in the Northeast (Basque Country) region of Spain.…”